Nursing home quality has been and continues to be a major concern for patients, their families, and health care policy makers. Over the last 2 decades, both the federal and state governments have engaged in efforts to address these concerns. These include the implementation of standard resident assessment and care planning tools, reforms of the state regulatory process, national and state publications of nursing home quality measures, national quality improvement activities by the Quality Improvement Organizations, and most recently the development of technical assistance (TA) programs in many states aimed at providing collaborative or non-punitive on-site consultation, training or sharing of best-practices with nursing facility staff. Despite these varied efforts, many quality problems persist, suggesting the need to understand the strengths and weaknesses of each of these initiatives. This study is designed to test the impact of the state initiated TA programs and their potential to contribute to better nursing home care. Nursing home TA programs vary substantially across states in terms of program structure (e.g., staffing pattern) and process (e.g., whether results of TA visits to facilities are shared with the state regulatory agency). Thus, their effectiveness is likely to vary as well. The natural variation in program characteristics offers us the opportunity to study the relationship between key components of the state TA program and high quality nursing home care. The main objective of the project is to inform policy by identifying aspects of the state TA program that contribute to better nursing home care. Specific aims are to test the hypotheses that the key structural and process characteristics of state TA programs are associated with better risk-adjusted health outcomes of nursing home residents and lower case mix adjusted deficiency citations. Data will be collected from survey of state TA programs and several secondary databases. Multivariate regression analyses including instrumental variable analysis will be used for hypothesis testing. PUBLIC HEALTH RELEVANCE: This study will examine the impact of the key structural and process components of state technical assistance programs on nursing home risk-adjusted health outcomes and case mix adjusted deficiency citations. We will combine data from different sources including a survey of state TA programs, and use statistical regression techniques including instrumental variable analysis for hypothesis testing.